Equipment, Supplies and Costs: What is Covered by Medicare?

At a Glance

What Medicare covers: Original Medicare Part B may cover medically necessary equipment used in the home, including walkers, wheelchairs, hospital beds, patient lifts, oxygen equipment, and CPAP devices.
Coverage is not automatic: A prescription starts the process, but the medical record must also support Medicare’s coverage requirements.
What patients may pay: After the Part B deductible, patients generally owe 20% of the Medicare-approved amount when the supplier accepts assignment.
What Medicare commonly excludes: Incontinence supplies, most bathroom safety equipment, ordinary disposable supplies, and the powered height feature of a full-electric hospital bed are generally not covered.
Where Medicaid may help: Health First Colorado may cover certain equipment and disposable supplies that Original Medicare excludes, subject to its own requirements and limits.
Why insurance orders take time: DME suppliers must review prescriptions, medical notes, coverage criteria, prior authorization requirements, and payer rules before dispensing covered equipment.
How to check an item: Gather your insurance information, prescription, medical notes, measurements, and expected length of need before contacting a medical supply company.

Understanding which DME is covered by Medicare can be difficult because coverage is not based only on whether a doctor recommends an item. Medicare looks at what the item is, why it is needed, where it will be used, whether the medical record supports the need, and whether the supplier meets Medicare’s requirements.

The direct answer is that Medicare Part B covers many types of medically necessary durable medical equipment for use in the home, but it does not cover every medical product, safety device, or disposable supply. Even when an item belongs to a covered category, the patient must still meet the specific coverage criteria for that product.

This guide focuses on Original Medicare Part B, explains how Medicare Advantage differs, and then looks at what Health First Colorado may cover when Medicare does not. It also reflects what we commonly see while helping customers navigate mobility aids, ostomy supplies, urological supplies, hospital beds, and patient lifts through Golden Gate Medical Supply.

What Counts as Durable Medical Equipment?

According to Medicare’s durable medical equipment coverage rules, an item generally must meet five basic conditions to qualify as DME. It must withstand repeated use, serve a medical purpose, usually be useful only to a person who is ill or injured, be appropriate for use in the home, and normally be expected to last at least three years.

This definition is one reason Medicare does not cover every product sold by a medical supply store. A product may improve safety or make daily activities easier without meeting Medicare’s definition of medically necessary home medical equipment.

It is also important to separate durable equipment from disposable medical supplies. Medicare Part B covers certain supplies connected to a covered benefit, such as diabetic testing supplies, ostomy supplies, urological supplies, CPAP accessories, and oxygen accessories, but it generally does not cover ordinary household medical supplies simply because they are used by someone with a medical condition.

What DME Is Covered by Medicare?

Medicare publishes a broad list of equipment that Part B may cover when the applicable medical-necessity and documentation requirements are satisfied. Common examples include:

Canes and crutches
Walkers and rollators
Commode chairs
Manual wheelchairs
Power wheelchairs and scooters
Hospital beds
Patient lifts
Oxygen equipment and accessories
CPAP and other respiratory-assist devices
Infusion pumps and related supplies
Blood glucose monitors and certain testing supplies
Continuous glucose monitors for eligible beneficiaries
High-frequency chest-wall oscillation devices
Certain pressure-reducing support surfaces
Powered lymphedema compression devices

The fact that an item appears in a covered category does not mean everyone with Medicare qualifies for it. Medicare evaluates whether the person’s condition, limitations, home use, prescribed equipment, and supporting medical notes meet the criteria for that exact item.

Walkers, Wheelchairs and Other Mobility Aids

Medicare may cover walkers, rollators, manual wheelchairs, power wheelchairs, and scooters when the person has a documented mobility limitation and the requested equipment is needed for activities inside the home. The medical record must explain why a simpler mobility aid would not adequately meet the person’s needs when a more advanced device is requested.

Power mobility equipment typically requires more extensive documentation than a basic walker. Certain power wheelchairs also require prior authorization, which means the supplier sends the medical documentation to Medicare for review before the equipment is provided.

Patient Lifts and Hoyer-Style Lifts

A patient lift may be covered when transfers between a bed and a chair, wheelchair, or commode are required and the person would otherwise be confined to the bed. A signed order alone is not enough; the treating provider’s notes must describe the transfer limitations and why the lift is medically necessary.

Different types of lifts have different criteria. Medicare may cover a qualifying hydraulic or mechanical patient lift, while a more specialized transfer system may require documentation showing that the person needs supine positioning or another advanced feature.

Hospital Beds

Medicare may cover a fixed-height, variable-height, or semi-electric hospital bed when the person meets the applicable criteria. A semi-electric bed can use powered controls to raise and lower the head and foot sections, while its overall height is generally adjusted manually.

Medicare does not ordinarily cover a total or full-electric hospital bed because CMS classifies the powered height-adjustment feature as a convenience feature rather than a medically necessary feature. The practical result is that a caregiver may still need to manually adjust the bed’s overall height even when the head and foot positions are powered.

Being bed confined does not automatically make the full-electric feature covered. The medical need for a hospital bed must be established separately from the convenience of powered height adjustment.

Oxygen, CPAP and Respiratory Equipment

Medicare may cover home oxygen equipment, oxygen accessories, CPAP therapy, bilevel respiratory devices, ventilators, suction pumps, and certain other respiratory equipment when the patient meets the clinical criteria. Testing results, diagnoses, trial periods, continued-use documentation, or follow-up visits may be required depending on the item.

Some respiratory equipment is rented rather than purchased immediately. Replacement supplies may also follow a schedule, and Medicare may require continued evidence that the person is using and benefiting from the treatment.

Ostomy and Urological Supplies

Medicare Part B may cover medically necessary ostomy supplies for a person who has had a colostomy, ileostomy, or urinary ostomy. Coverage generally applies to the amount and type of supplies ordered by the treating provider based on the person’s condition.

Certain urological supplies, including qualifying urinary catheters and related products, may also be covered under Medicare’s prosthetic-device benefit. Quantities, product types, documentation, and replacement frequency remain subject to Medicare rules.

Diabetic Equipment and Supplies

Medicare may cover blood glucose monitors, test strips, lancets, control solutions, continuous glucose monitors, and related supplies when eligibility criteria are met. The amount covered may depend on whether the person uses insulin, how often testing is medically necessary, and whether additional documentation supports quantities beyond the standard allowance.

A continuous glucose monitor has its own eligibility and follow-up requirements. A provider must evaluate the patient, order the equipment, and document that the person meets Medicare’s criteria.

Original Medicare DME Costs

Under Original Medicare Part B, the patient generally pays the Part B deductible and then 20% of the Medicare-approved amount for covered DME when the supplier accepts assignment. Medicare generally pays the remaining 80% of the approved amount.

The Medicare-approved amount is not necessarily the same as the supplier’s retail price. It is the payment amount Medicare recognizes for the billing code under its applicable payment rules.

Before receiving equipment, patients should ask:

Is the supplier enrolled in Medicare?
Does the supplier participate in Medicare?
Will the supplier accept assignment for this claim?
If the item is rented, will assignment be accepted for every rental month?
What deductible, coinsurance, upgrade, or noncovered amount may be due?

A participating Medicare supplier must accept assignment. A nonparticipating supplier may choose whether to accept assignment and could charge more or require the patient to pay upfront, depending on the circumstances.

What if the 20% Coinsurance Is Too Expensive?

Patients who cannot afford their coinsurance should ask whether they qualify for Medicaid, a Medicare Savings Program, Medigap coverage, or another secondary insurance benefit. These programs may help with eligible Medicare cost-sharing, but the exact result depends on the person’s coverage.

Some suppliers may also have a financial-assistance or hardship-review process. That is separate from Medicare coverage, varies by company, and is not guaranteed; a supplier cannot simply make Medicare pay the patient’s 20% share.

How Medicare Advantage Plans Cover DME

Medicare Advantage, also called Medicare Part C, is an alternative way to receive Medicare Part A and Part B benefits through a private insurance company approved by Medicare. These plans must provide at least the medically necessary Part A and Part B benefits that Original Medicare covers.

The underlying equipment may therefore be covered under similar medical criteria, but the process can be different. A Medicare Advantage plan may require the patient to use an in-network DME supplier, obtain prior authorization, follow referral rules, or pay a plan-specific copayment or coinsurance.

It is safer to say that Medicare Advantage generally covers the applicable Part B DME benefit—not that every plan uses the same payment rate or patient cost as Original Medicare. Before ordering equipment, contact the plan or ask the supplier to verify:

Whether the supplier is in network
Whether prior authorization is required
Whether the item must be rented or purchased
What the patient’s copayment or coinsurance will be
Whether the plan offers any supplemental equipment or safety benefits

Medicare and Health First Colorado Coverage Comparison

The table below provides a practical comparison of common categories. It is a general guide rather than a guarantee because both programs use item-specific billing codes, medical criteria, quantity limits, and documentation requirements.

Equipment or supply	Original Medicare	Health First Colorado	Common requirements or limitations
Walkers and rollators	May be covered	May be covered	Prescription, mobility limitation, home-use need, and supporting medical notes
Manual wheelchairs	May be covered	May be covered	Mobility assessment, medical necessity, measurements, and possible prior authorization
Power wheelchairs and scooters	May be covered	May be covered	Extensive mobility documentation, evaluation, home-use criteria, and prior authorization
Patient or Hoyer-style lifts	May be covered	May be covered	Transfer limitations must be documented; prior authorization or payer questionnaire may apply
Fixed or semi-electric hospital beds	May be covered	May be covered	Positioning need, frequency of position changes, face-to-face documentation, and prior authorization may apply
Full-electric hospital beds	Powered height feature generally not covered	May be covered when the applicable Colorado criteria are met	Health First Colorado lists total-electric bed codes, but approval still requires medical documentation and prior authorization
Oxygen and respiratory equipment	May be covered	May be covered	Diagnosis, testing, prescribed flow or settings, continued need, and supplier requirements
CPAP and BiPAP devices	May be covered	May be covered	Sleep study or qualifying diagnosis, trial requirements, continued-use documentation, and prior authorization
Ostomy supplies	May be covered	May be covered	Qualifying ostomy, prescription, medically necessary quantities, and refill documentation
Urological supplies	Certain supplies may be covered	May be covered	Diagnosis, product type, frequency, quantity, and medical documentation
Incontinence briefs and protective underwear	Not covered by Original Medicare	May be covered	Health First Colorado eligibility, medical necessity, age requirements, quantities, and applicable limits
Underpads and liners	Not generally covered by Original Medicare as incontinence supplies	May be covered	Product code, medical need, quantity limits, and current Medicaid rules
Commode chairs	May be covered in qualifying circumstances	May be covered	The patient must meet the program’s criteria for the specific commode
Shower chairs, bath benches and transfer benches	Generally not covered	Certain items may be covered	Health First Colorado coverage is code-specific and may require prior authorization
Raised toilet seats and seat risers	Generally not covered	Coverage depends on the exact item and code	Often treated differently from a medically necessary commode
Grab bars	Not covered as DME	May be available only through specific benefits or programs	Not every home-safety or modification benefit is part of standard DME coverage
Ordinary bandages and gauze	Generally not covered as routine home supplies	Certain medically necessary treatment supplies may be covered	Coverage depends on the wound, product, billing code, quantity, and documentation
Diabetic monitors and testing supplies	May be covered	May be covered	Diagnosis, testing frequency, product requirements, and prescribed quantities

Please Note:

A product appearing on a Medicare or Health First Colorado code list does not guarantee approval. Eligibility, medical necessity, documentation, benefit limits, prior authorization, and supplier participation must still be verified.

What Medicare Commonly Does Not Cover

Medicare excludes many products because it considers them hygienic, convenience-based, primarily useful for general household purposes, or insufficiently medical in nature. This is where patients are often surprised, because a product can still be extremely useful for safety and independence.

Bathroom Safety Equipment

Original Medicare generally does not cover bathtub seats, standard shower chairs, ordinary bath benches, grab bars, raised toilet seats, or similar bathroom safety products. CMS commonly categorizes these products as convenience, hygienic, or self-help items rather than covered DME.

A commode chair is an important exception. Medicare may cover a medically necessary commode when the person meets its coverage requirements, but that does not mean all toilet-safety equipment or bathroom products are covered.

Incontinence Supplies

Original Medicare does not cover adult briefs, protective underwear, disposable underpads, or other routine incontinence products. The patient generally pays the full cost unless another insurance program provides coverage.

Some Medicare Advantage plans may offer limited supplemental over-the-counter or personal-care benefits, but these vary by plan. A supplemental allowance is not the same as Original Medicare Part B coverage.

Full-Electric Hospital Beds

Medicare may cover a semi-electric hospital bed when the patient meets the required criteria, but it generally denies the full-electric height-adjustment feature. CMS considers powered height adjustment a convenience feature.

A patient may still choose a full-electric bed as an upgrade, but the supplier must explain the expected coverage and potential financial responsibility before providing it. The patient should not assume that being bed confined, requiring caregiver support, or having a prescription automatically makes the upgrade payable.

Common Disposable Medical Supplies

Medicare Part B usually does not cover ordinary supplies used in the home, such as standard bandages and gauze. Certain disposable products are covered only when they are part of a separate Medicare benefit, such as ostomy supplies, urological supplies, diabetic testing supplies, surgical dressings that meet coverage criteria, or supplies used with covered equipment.

This is why the phrase “medical supply” does not automatically mean “Medicare-covered supply.” Each product must be connected to a recognized benefit category and meet that category’s requirements.

What an Advance Beneficiary Notice Actually Does

An Advance Beneficiary Notice of Noncoverage, commonly called an ABN, is used with Original Medicare when a provider or supplier expects Medicare to deny an item or service. It explains why payment is uncertain and gives the beneficiary choices before receiving the item.

An ABN is not a request that forces Medicare to cover an upgrade, a noncovered product, or a convenience feature. It can allow a patient to choose to receive the item and have a claim submitted, but Medicare may still deny the claim.

A properly issued ABN may transfer financial responsibility to the patient if Medicare does not pay. Patients should read the notice carefully and ask:

Why does the supplier expect Medicare to deny the item?
Is the entire product expected to be denied, or only an upgrade?
What is the estimated patient cost?
Will a claim still be submitted to Medicare?
What alternatives are expected to be covered?
What appeal options may be available after a denial?

An ABN should not be confused with financial assistance or a coinsurance-waiver form. It primarily documents that the patient was informed of likely noncoverage before choosing whether to receive the item.

What Health First Colorado May Cover When Medicare Does Not

Health First Colorado covers durable medical equipment, prosthetics, orthotics, and disposable medical supplies when they meet the program’s rules. Its benefit includes categories that Original Medicare either does not cover or covers more narrowly.

Health First Colorado may cover certain equipment and disposable medical supplies that Original Medicare excludes, but coverage still depends on eligibility, medical necessity, documentation, benefit limits, and the applicable billing code.

Examples may include:

Disposable briefs and protective underwear
Underpads and liners
Certain bath and bathroom equipment
Certain full-electric hospital beds
Patient lifts and specialized transfer equipment
Wheelchair accessories and positioning systems
Ostomy supplies
Urological and irrigation supplies
Enteral nutrition products and supplies
Wound care and other disposable treatment supplies

Many Health First Colorado equipment items require a Prior Authorization Request, commonly called a PAR. Approval must generally be obtained before the item is delivered, and the supplier must submit the order, medical records, questionnaire, face-to-face documentation, measurements, or other required information.

Health First Colorado also distinguishes between equipment that is purchased, rented temporarily, or rented until the purchase price is reached. Oxygen equipment and ventilators may remain continuous rentals because they require ongoing service.

How Medicare and Medicaid Work Together

When a patient has both Medicare and Health First Colorado, Medicare is generally billed as the primary payer for items that fall under the Medicare benefit. Health First Colorado then processes the eligible remaining amount under its secondary-payer rules.

For a covered Original Medicare item, Medicare commonly pays 80% of the approved amount after the deductible, and the patient is responsible for the remaining 20%. If the person has active Health First Colorado as secondary coverage, Medicaid may pay eligible Medicare cost-sharing according to its rules.

When Medicare denies an item that Health First Colorado may cover, the supplier may need to submit the Medicare denial or crossover information before Medicaid can process the claim. A Medicare denial does not automatically mean Medicaid will pay; the product must still be a Health First Colorado benefit and satisfy Medicaid’s requirements.

The process can be summarized this way:

The supplier determines whether Medicare is primary for the item.
Medicare processes and pays or denies the claim.
The claim or Medicare payment information crosses over or is submitted to Health First Colorado.
Health First Colorado applies its own coverage, documentation, authorization, and payment rules.
The supplier determines whether any permitted patient responsibility remains.

The Medicaid Buy-In Program for Working Adults With Disabilities

Some working Coloradans with disabilities assume they cannot qualify for Medicaid because they earn income from a job. Colorado’s Health First Colorado Buy-In Program for Working Adults with Disabilities may allow eligible individuals to receive Medicaid coverage while continuing to work.

The program is intended for working adults with a qualifying disability whose adjusted income falls within the program’s limits. Colorado currently applies an income standard based on 450% of the federal poverty level after applicable disregards, and some members may owe a monthly premium.

This program can be worth investigating when a person has Medicare but needs help with coinsurance or requires supplies that Original Medicare does not cover, such as incontinence products. Enrollment does not guarantee that every requested DME item will be approved, but it may provide access to the broader Health First Colorado DMEPOS benefit.

Eligibility is determined by the appropriate state or county agency, not by the medical supply company. A person interested in the program should contact their local county Department of Human Services or review the Health First Colorado Buy-In Program for Working Adults with Disabilities.

Why a Prescription Does Not Guarantee Insurance Coverage

One of the most common misunderstandings we see is: “My doctor wrote an order, so insurance has to cover it.” A prescription is necessary for many equipment orders, but it is only one part of the coverage process.

The prescription tells the supplier what the provider ordered. The medical record must explain why the patient needs it and show that the patient meets the payer’s criteria.

For example, an order that says “hospital bed” may not explain:

Why positioning cannot be achieved in an ordinary bed
How often the patient needs to change position
Whether immediate position changes are required
How long the equipment will be needed
Which hospital-bed features are medically necessary
Whether the patient or caregiver can safely operate the equipment

The DME supplier is responsible for reviewing the paperwork before billing insurance. Providing equipment without sufficient documentation can result in a denial, repayment demand, audit issue, or improper charge to the patient.

Why Insurance-Covered Equipment Can Take Longer

A customer may be able to purchase an available item out of pocket without waiting for insurance review. An insurance-covered order normally takes longer because the supplier must confirm eligibility, obtain the order and medical notes, match the documentation to the correct billing code, request missing information, and submit prior authorization when required.

The supplier may also need measurements, a home-use assessment, product-specific questionnaires, proof of a face-to-face visit, trial documentation, or records showing why a less complex item will not work. The timeline depends heavily on how quickly the complete medical documentation is received.

At Golden Gate Medical Supply, the review is not intended to create an unnecessary delay. It is part of the supplier’s responsibility to make sure the documentation supports the medical necessity of the equipment and that the claim is submitted correctly.

What We See Most Often at Our Counter

Many customers arrive expecting Medicare and Medicaid to cover the same products. They are surprised when Medicare excludes incontinence supplies or bathroom safety equipment but Health First Colorado may cover certain items.

Another common issue is incomplete documentation. The patient may have a signed prescription, while the clinical notes do not explain the diagnosis, functional limitation, length of need, failed alternatives, transfer needs, positioning needs, or other facts required by the insurance company.

Customers also understandably expect equipment immediately once the order reaches the supplier. The fastest way to avoid preventable delays is to have the prescribing office send both the signed order and the clinical notes supporting the requested equipment.

What to Gather Before Contacting a DME Supplier

Having the following information available can help the supplier evaluate the request more efficiently. Not every item requires everything listed, but this provides a useful starting point.

Patient’s full name and date of birth
Current address and telephone number
Medicare, Medicaid, or Medicare Advantage identification cards
Information about any secondary insurance
Prescribing provider’s name and contact information
Signed prescription or written order
Recent medical notes related to the equipment
Diagnosis and explanation of the functional limitation
Expected length of need
Height, weight, and other required measurements
Current equipment being used
Reason replacement or a more advanced item is needed
Whether the equipment is needed after a hospital or facility discharge
Whether home delivery, installation, fitting, or caregiver education will be required

A Call Script for Checking DME Coverage

A short, organized explanation can help a medical supply company understand the request. The patient or caregiver can use this script as a starting point:

“I am trying to find out whether my insurance may cover a name of equipment or supply. I have Original Medicare, Medicare Advantage, Health First Colorado, or other coverage. My provider is provider name, and the equipment is needed because brief explanation. I have a prescription and can ask the provider to send the supporting medical notes. Can you tell me what documentation you need, whether prior authorization is required, and what my estimated responsibility may be?”

The supplier may not be able to provide a final answer during the first contact. Coverage often depends on reviewing the exact order, medical notes, billing code, insurance plan, and current benefit requirements.

Receiving Equipment in Colorado

Golden Gate Medical Supply may ship many general medical supplies directly to patients when shipping is safe, practical, and permitted by the payer. This can be useful for recurring ostomy, urology, incontinence, and other routine supply orders throughout Colorado.

Larger equipment such as hospital beds and patient lifts may require delivery, assembly, fitting, safety checks, or education for the patient and caregiver. Because the DME supplier is responsible for making sure equipment is provided and used appropriately, these products may require a local delivery arrangement rather than ordinary parcel shipping.

Check Your Coverage Before Ordering

The best way to determine whether an item may be covered is to review the specific product, insurance plan, prescription, and medical documentation together. General coverage lists are helpful, but they cannot confirm an individual claim.

Patients and caregivers can submit a request through the Golden Gate Medical Supply coverage-check form. Our team will review the information, determine whether the request is something we may be able to assist with, and explain the next steps or additional documentation that may be needed.

Medicare, Medicare Advantage, and Health First Colorado each apply different procedures even when they cover similar products. Confirming the details before purchasing or accepting delivery can help prevent unexpected costs, denials, and avoidable delays.